Passive Aortic Counterpulsation to Reduce Pressure Pulse During Aortic Prosthesis Insertion and Reduce Endoleaks Formation: A Preliminary In Silico Investigation

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Abstract
Over 10% of patients undergoing aortic endograft implantation experience endoleaks within a few years. In the case of type 1a endoleaks, a crack forms between the aorta and the prosthesis collar, allowing blood to pass. This blood fills the aneurysmal sac and can lead to its rupture. None of the strategies, such as prostheses with barbs and hooks or ad hoc pharmacological therapies, can prevent the phenomenon. An alternative approach is to reduce diameter oscillations due to pulsating pressure to improve the endoprosthesis adhesion to the internal vessel walls during the initial post-implantation phases. To reach this objective, we propose to use a passive intra-aortic balloon pump (PIABP) inserted and then maintained inside the vessel immediately after the surgical procedure. We tested our hypothesis in a mechanical mock of the cardiovascular system. A silicon aorta with physiological behavior was created for this purpose. The PIABP was inflated to increasing pressures between systolic and diastolic values (120/80 mmHg). For each aorta and each condition, the variations in aortic diameter between systole and diastole, and the pressure variations, were measured. For the normal aorta, with a PIABP pressure of 110 mmHg, the variations in diameter were reduced by 38%. Assuming an endoprosthesis with a diameter of 30 mm (oversized by 5% compared to the diastolic diameter), the time the oscillations are higher than 30 mm is also reduced by 36%. The results are positive and suggest the usefulness of a biomechanical approach to the problem of type 1a endoleaks. Further in silico and clinical trials are necessary to validate the method.

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